# Factors Associated with Retention in Routine Well-Care Visits Among Children of Adolescent Mothers Living With and Without HIV: A Community-Based Study in the Eastern Cape, South Africa

## TL;DR

This study examines factors affecting regular well-care visits for children of adolescent mothers in South Africa, finding that rural location and higher maternal education improve retention.

## Contribution

The study identifies specific factors associated with retention in well-care visits for children of adolescent mothers, including maternal education and geographic location.

## Key findings

- Retention in well-care visits was highest in rural areas compared to urban areas.
- Children of mothers with secondary education had better retention than those with primary education.
- Food security and child support grants showed weak but positive associations with retention.

## Abstract

To describe well-care visit attendance among children of adolescent mothers living with HIV and HIV-negative adolescent mothers and identify factors associated with optimal retention in the well-care visit schedule up to 18 months.

Cross-sectional data were used from a community-based observational cohort study of adolescent mothers (10–19 years; n=481) and their children (≥19 months old; n=502) in the Eastern Cape, South Africa.

Optimal well-care visit retention up to 18 months was defined as attending visits within 4 weeks of the recommended child age, attending the 18-month visit and missing no more than one scheduled visit.

Attendance was highest at the 6-week visit (88.4%; 95% confidence interval (CI) 85.6% to 91.3%) and lowest at the 18-month visit (58.0%, 95% CI 53.6% to 62.3%). About one-third (36.1%; 95% CI 31.8% to 40.3%) of children were retained to 18 months. Retention was highest among children living in rural vs urban areas (adjusted odds ratio (aOR)=2.01, 95% CI 1.32 to 3.06), those born to mothers whose highest education at pregnancy was secondary versus primary school (aOR=2.73, 95% CI 1.60 to 4.65), born via caesarean section vs vaginal birth (aOR=1.65, 95% CI 1.05 to 2.60) and living closer to the clinic (aOR=0.52, 95% CI 0.28 to 0.96 for long vs short distance). There was weak evidence that retention was lower among children of mothers living with HIV (aOR=0.64, 95% CI 0.40 to 1.02) and higher among food-secure children (aOR=2.18, 95% CI 0.96 to 4.96) and those receiving the child support grant (aOR=1.71, 95% CI 0.92 to 3.16).

Universal interventions are needed for retention beyond the neonatal period for children of adolescent mothers living with HIV and HIV-negative adolescent mothers. Interventions must address structural barriers, especially for adolescent mothers with primary education and in urban areas. Future research should examine the underlying mechanisms linking mode of delivery with well-care retention.